The association of distress and depression screening measures and other electronic health record information with adjuvant endocrine therapy persistence.

Abstract

Purpose: Few risk factors for early adjuvant endocrine discontinuation have been identified, but clinical trials suggest pre-AET symptom burden might be important. We sought to assess this in an academic practice.

Methods: We examined baseline and up to five years of follow-up information for postmenopausal women with stage I-III hormone-receptor positive breast cancer 2014-2019 receiving oncologist prescriptions for AET. The Distress Thermometer (DT) and its problem list, the Patient Health Questionnaire 2/9 (PHQ 2/9), cancer extent of disease and treatments, comorbidities, sociodemographics, and pharmacy prescription fill dates were abstracted from the cancer registry and electronic health record (EHR). The association of these variables with early AET prescription fill discontinuation (prior to 5 years) was examined using survival analysis and Bayesian machine learning, with censoring for recurrence, death, or provider change.

Results: Among the cohort of 961 women (mean 68.8 years, SD 2.88), 91.6% were white, 74.6% had Stage I disease, and 45.0% a pre-AET DT showing high distress (> 3). The median follow-up time was 820 (25, 75% 448,1282) days, and 29.6% discontinued early. Neither the DT score nor the PHQ 2/9 was associated with nonadherence, although three physical problems were modestly associated. Over 25% of women who stopped filling prescriptions did not have their prescriptions discontinued in the EHR.

Conclusions: Several commonly available baseline EHR variables were not associated with early discontinuation, although some symptoms may have modest effects. Many women who discontinued still had EHR prescriptions, suggesting that physicians could use prescription fill information to intervene earlier.